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Calhoun MASA SBC

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Emergency Ground Ambulance Coverage1Your out-of-pocket expenses for your emergency ground transportation to a medical facility are covered with MASA.Emergency Air Ambulance Coverage1Your out-of-pocket expenses for your emergency air transportation to a medical facility are covered with MASA.Hospital to Hospital Ambulance Coverage1When specialized care is required but not available at the initial emergency facility, your out-of-pocket expenses for the ground or air ambulance transfer to the nearest appropriate medical facility are covered with MASA.Repatriation Near Home Coverage1Should you need continued care and your care provider has approved moving you to a hospital nearer to your home, MASA coordinates and covers the expense for ambulance transportation to the approved medical facility.Stay prepared with MASA® AccessSMComprehensive coverage and care for emergency transport.Our Emergent Plus membership plan includes:Coverage territories 1: United States and Canada. DisclaimersThis material is for informational purposes only and does not provide any coverage. The benets listed, and the descriptions thereof, do not guarantee coverage and do not represent the full terms and conditions applicable for usage and may only be oered in some memberships or policies. Premiums, benets, and coverage vary depending on the plan selected. For a complete list of benets, premiums, terms, conditions, and restrictions, please refer to the applicable member services agreement or policy for your state. For additional information and disclosures about MASA plans, visit: https://info.masamts.com/masa-mts-disclaimersAbout MASAMASA is coverage and care you can count on to protect you from the unexpected. With us, there is no “out-of-network” ambulance. Just send us the bill when it arrives and we’ll work to ensure charges are covered. Plus, we’ll be there for you beyond your initial ride, with expert coordination services on call to manage complex transport needs during or after your emergency — such as transferring you and your loved ones home safely. Protect yourself, your family, and your family’s nancial future with MASA. Did you know?MASA protects families against uncovered costs for emergency transportation and provides connections with care services. Source: NEMSIS, National EMS Data Report, 202351.3 million emergency responses occur each year$14/month

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Stay prepared with MASA® AccessSMEmergency Ground Ambulance Coverage2Your out-of-pocket expenses for your emergency ground transportation to a medical facility are covered with MASA.Emergency Air Ambulance Coverage2Your out-of-pocket expenses for your emergency air transportation to a medical facility are covered with MASA.Hospital to Hospital Ambulance Coverage2When specialized care is required but not available at the initial emergency facility, your out-of-pocket expenses for the ground or air ambulance transfer to the nearest appropriate medical facility are covered with MASA.Repatriation to Hospital Near Home Coverage4Should you need continued care and your care provider has approved moving you to a hospital nearer to your home, MASA coordinates and covers the expense for ambulance transportation to the approved medical facility. Patient Return Transportation Coverage4Once you’re discharged from medical care and able to travel without medical transport, MASA coordinates and covers the costs associated with your commercial airline transport home.Comprehensive coverage and care for emergency transport.Our Platinum membership plan includes:About MASAMASA is coverage and care you can count on to protect you from the unexpected. With us, there is no “out-of-network” ambulance. Just send us the bill when it arrives and we’ll work to ensure charges are covered. Plus, we’ll be there for you beyond your initial ride, with expert coordination services on call to manage complex transport needs during or after your emergency — such as transferring you and your loved ones home safely. Protect yourself, your family, and your family’s nancial future with MASA. Did you know?MASA protects families against uncovered costs for emergency transportation and provides connections with care services. Source: NEMSIS, National EMS Data Report, 202351.3 million emergency responses occur each year$39/month

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Coverage territories 1: United States only.2: United States and Canada.3: United States, Canada, Mexico, the Caribbean (excluding Cuba), the Bahamas and Bermuda.4: Worldwide coverage to include any region with the exclusion of Antarctica and not prohibited by U.S. law or under certain U.S. travel advisories as long as the member has provided ten (10) day notice. DisclaimersThis material is for informational purposes only and does not provide any coverage. The benets listed, and the descriptions thereof, do not guarantee coverage and do not represent the full terms and conditions applicable for usage and may only be oered in some memberships or policies. Premiums, benets, and coverage vary depending on the plan selected. For a complete list of benets, premiums, terms, conditions, and restrictions, please refer to the applicable member services agreement or policy for your state. For additional information and disclosures about MASA plans, visit: https://info.masamts.com/masa-mts-disclaimers Companion Transportation Coverage3MASA coordinates services and covers the cost for a companion to accompany you during your emergency air ambulance transport.Mortal Remains Transportation Coverage4In the event that you pass away more than 100 miles from home, MASA coordinates services and covers the cost of air transport for your remains to be returned home. Vehicle & RV Return Coverage3Should a travel emergency occur requiring you to leave your vehicle or RV by ambulance, MASA provides services and covers expenses associated with returning your vehicle or RV to your home.Organ Retrieval & Organ Recipient Transportation Coverage1Should you need an organ transplant, MASA coordinates and covers the cost of getting you or the organ to the transplant location.Hospital Visitor Transportation Coverage3Should you be hospitalized more than 100 miles from home, MASA coordinates and covers the cost of round-trip air transportation for a companion to join you. Minor Return Transportation Coverage3In the event your minor child traveling with you is left unattended due to your emergency transport, MASA coordinates services and covers expenses to return your child safely home.Pet Return Transportation Coverage3If you are traveling with your pets and an emergency occurs requiring your medical transport, MASA coordinates services and covers expenses for returning up to two pets to your home.

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Benet Emergent Plus PlatinumEmergency Air Ambulance CoverageEmergency Ground Ambulance CoverageHospital to Hospital Ambulance CoverageRepatriation Near Home CoverageMinor Return Transportation CoveragePet Return Transportation CoverageCompanion Transportation CoverageHospital Visitor Transportation CoveragePatient Return Transportation CoverageMortal Remains Transportation CoverageVehicle & RV Return CoverageOrgan Retrieval & Organ Recipient Transportation CoverageFamily CoverageMASA Memberships A MASA MTS Membership provides the ultimate protection at an aordable rate for emergency ground and air transportation expenses.While our critical benets are included in the Emergent Plus membership, the Platinum plan includes additional services. Whether you’d like to defend your family from costly emergency ambulance transports or gain peace of mind, MASA MTS has you covered.MASA Memberships One Sheet_Emergent Plus Platinum 2023_13 33 3312222112334Coverage Territories 1: Worldwide Coverage — benets shall extend Worldwide. Coverage shall automatically extend to the United States, Canada, Mexico, the Caribbean (excluding Cuba), the Bahamas and Bermuda (collectively, “Basic Coverage Area”) (excluding countries referenced on the Oce of Foreign Assets Control (“OFAC”) countries, and Antarctica), and extend elsewhere contingent upon ten (10) day prior notice of such travel. Notice may be provided by (i) certied mail, return receipt requested, to the MASA Corporate oce; (ii) electronic mail, including delivery conrmation; or (iii) facsimile, including conrmation of delivery, and MASA’s written acknowledgment. Notice must include a travel itinerary of travel destinations and dates. Unless otherwise authorized by MASA MTS in writing, Worldwide coverage shall apply up to ninety (90) days per trip.2: Basic Coverage Area — benets shall extend to the United States, Canada, Mexico, the Caribbean (excluding Cuba), the Bahamas and Bermuda. Vehicle & RV Return Coverage shall be limited to only rental day prior notice of such travel. Notice may be provided by (i) certied mail, return receipt requested, to the MASA Corporate oce; vehicles in Hawaii, the Caribbean (excluding Cuba), the Bahamas and Bermuda.3: United States and Canada Only — benets shall only be provided in the United States and Canada.4: United States Only — benets shall only be provided in the United States.This material is for informational purposes only and does not provide any coverage. The benets listed, and the descriptions thereof, do not represent the full terms and conditions applicable for usage and may only be oered in some memberships or policies. Premiums and benets vary depending on the plan selected. For a complete list of benets, premiums, terms, conditions, and restrictions, please refer to the applicable member services agreement or policy for your state. For additional information and disclosures about MASA MTS plans, visit: https://info.masamts.com/masa-mts-disclaimers

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How to use your MASA benetsTransportation coordination servicesClaimsMASA connections• Repatriation Near Home Coverage• Child, Pet, and Vehicle Return Coverages• Companion Transportation Coverage• Hospital Visitor Transportation Coverage• Patient Return Transportation Coverage• Sick While Away from Home Expense Protection• Organ Retrieval & Organ Recipient Transport Coverage• Mortal Remains Transportation Coverage• Emergency Ground Ambulance Coverage• Emergency Air Ambulance Coverage• Hospital to Hospital Ambulance Coverage• Post-Admission Continued Care Transportation CoverageWhen to le your claim:When you receive the ambulance bill.Note: Be sure to le within 180 days of the transport.How to le your claim:Access transport services for the following benets:Benets that you submit claims for include:Member services: (800) 643-9023Member site: masaaccess.com/member MASA appWhen to access:During or immediately following your emergency care treatment.How to access:Call 800-643-9023.The MASA Transport Team is available 24/7/365 to assist you and will begin making the necessary arrangements, including working with your medical team.Note: If you are traveling out of the U.S., please submit your dates of travel through the member portal or to travel@masaglobal.com.View your benets online at: masaaccess.com/member or through the MASA app.Check the status of your claim at: masaaccess.com/member, through the MASA app, or call (800) 643-9023.Online: masaaccess.com/memberEmail: ambulanceclaims@masaglobal.comFax: (877) 681-2399Mail: MASA Global / ATTN: Claims1250 S. Pine Island Road, Suite 500 Plantation, FL 33324Note: To process your claim, in addition to the invoice we may require your health insurance claim form (HICFA) and explanation of benets (EOB), the ambulance run notes, and the ambulance provider’s W9. MASA claim specialists will advise you on how to obtain these.Include your member numberThis material is for informational purposes only and does not provide any coverage. Not all MASA products and services are available to residents of all states.The benets listed, and the descriptions thereof, do not represent the full terms and conditions applicable for usage and may only be oered in some memberships or policies. For a complete list of coverage and exclusions, please refer to the applicable member services agreement or policy for your state. For information about MASA plan benets, visit: https://info.masamts.com/masa-mts-disclaimers.